ANAHEIM, CALIF. Liquid injectable silicone can be a highly effective means of tissue augmentation, especially for acne scarring and HIV-related lipoatrophy, Derek Jones, M.D., said at a cosmetic dermatology seminar sponsored by the Skin Disease Education Foundation.
"This can be an ideal filler that is long lasting and cosmetically elegant," said Dr. Jones of the department of dermatology at the University of California, Los Angeles.
A "wealth of anecdotal data" indicates that liquid injectable silicone is safe and effective, but the following critical rules are key to its safe usage, he said:
▸ Use only pure, Food and Drug Administration-approved, injectable-grade liquid silicone; in the United States that means only Silikon-1000, made by Alcon Laboratories. The product has FDA approval for intraocular injection to treat retinal detachment, but it may be legally used off label, under the 1997 FDA modernization act that allowed medical devices to be used off label.
It's important to note, however, that the law prohibits advertisement of off-label uses, and malpractice insurance carriers have different policies regarding such uses.
▸ Adhere to a strict serial puncture microdroplet technique, defined as 0.01 cc injected into the immediate subdermal plane or deeper at 2- to 4-mm intervals, with no double pass in the same plane. Intradermal injection should be strongly avoided except among the most skilled practitioners.
The technique is necessary to allow a fibroproliferative response that develops around each microdroplet between treatments, not only causing each droplet to become anchored and less likely to drift but contributing to further augmentation, Dr. Jones said.
"This is an oil, and if you inject a lot all at once, it's like throwing olive oil on the floorit's going to spread out and track tissue planes along the path of least resistance," he said. "But the microdroplet technique addresses this problem."
▸ Inject only small volumes2 cc or less for lipoatrophy, or 0.5 cc or less for other indications. "Avoid the temptation to use larger volumes," Dr. Jones said, adding that injections should be spread out at intervals of at least 4 weeks.
In addition to these three critical rules, important considerations for silicone use include informing patients that liquid injectable silicone is permanent, and that its use is still investigational and likely to remain so for years. And, while patients can resume a normal routine immediately, they are advised to avoid activities that could predispose them to blunt trauma.
Dr. Jones demonstrated the injection technique on a patient with HIV-related facial lipoatrophy at the conference and said that most patients are highly pleased with the results.
Liquid silicone injections "really give an extraordinarily natural-appearing correction," he said. "When you touch the cheeks of these individuals, they feel nice, soft, and supple, and the injections really can restore subtle and refined facial contours."
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This HIV patient shows lipoatrophy before his silicone treatment.
Augmentation with injectable silicone gives a natural-appearing correction. Photos courtesy Dr. Derek Jones